Jacinta Ankus on behalf of Catholic HIV and AIDS Services Inc

Background Officially began responding to PNG’s HIV epidemic in 2004 Initial emphasis was on standalone VCT sites, community awareness and policy development Availability of ART has seen expansion of treatment Majority of services are now integrated in to existing health facilities PICT and couple counselling are key components of the program There are 246 Catholic-run health facilities across Papua New Guinea. The Catholic Church is the largest HIV service provider and the largest non-government health service provider in the country. Most of these facilities are in remote and rural areas 89 facilities, or 36%, are in the HIV high burden provinces In addition, the Catholic Church operates 1 nurses’ training school and 4 CHW schools. Graduates from these institutes go on to work in facilities across PNG, mostly in remote and rural areas, run by the government and Churches A third of all HIV counselling and testing performed in PNG over the past five years has been done in Catholic-run facilities Almost a third of all people on ART get their medication from Catholic-run facilities

How the programs and partners contribute Provision of funding and technical assistance Policy development on the national level Training of staff Quality assurance Innovation (men’s and youth clinics; piloted PPTCT Program) Expanded service delivery, particularly VCT, antenatal testing and provision of ART This contributes to high quality services that the community TRUSTS. CHASI’s partners this financial year are: Catholic Church Commissions such as Education and Family Life (sharing information and resources; joint programming where applicable) National Department of Health, including the Central Public Health Laboratory (funding of salaries and facilities; provision of drugs; training; accreditation of staff and facilities; monitoring; quality assurance and compliance) Australian Aid Program (funding of training, outreach and awareness, equipment, facilities and salaries) Australasian Society for HIV Medicine (training, mentoring, quality assurance) PNG Sexual Health Society (training, mentoring, quality assurance) Global Fund and Oil Search Health Foundation (funding of salaries, training, equipment; CHASI is a member of the Country Co-ordinating Mechanism) Church Partnership Program: Caritas Australia and Australian Aid Program (salaries of HIV Co-ordinators, meetings and training) World Health Organisation (technical assistance, policy development) UNAIDS (data analysis and surveillance) Catholic HIV and AIDS Network (information sharing, advocacy) National AIDS Council and Provincial AIDS Committees UNAIDS (data analysis and surveillance) Clinton Health Access Initiative (funding for ART, technical assistance, training) Burnet Institute (training, jointly hosting a conference) UNICEF (research, PPTCT, anti-violence programs)

Benefits of working with a range of partners Exposed to latest developments from around the world Access to highly skilled health professionals and trainers Sets a benchmark for our own performance Enables programs, including ART, to be scaled up Can offer a broader range of services Able to contribute to policy development Regular professional development for staff Contribute to national surveillance system Exposed to latest developments from around the world – because of its broad network, CHASI was able to take on new developments at the earliest possible time. This includes the PPTCT Program, which was originally trialled at facilities in Mingende, Chimbu Province and the Southern Highlands. That program was so successful that it has been adopted nationally Access to highly skilled health professionals and trainers – ASHM, the NDoH and the PNGSHS have been pivotal in providing training. These trainers are highly skilled. They provide opportunities for learning and improvement that otherwise would not be possible Sets a benchmark for our own performance – working with a range of partners enables us to identify the gaps in our service provision. However, it also helps us to realise that in many areas we are performing very well, often in difficult and dangerous situations Enables programs, including ART, to be scaled up – ART is now internationally recognised as an effective prevention strategy. Without support from partners especially ASHM, PNGSHS and the NDoH, CHASI could not have trained as many prescribers as it has. Trained prescribers has enabled ART to be rolled out to more than 50 Catholic-run facilities across the country. ART is acting as a preventative measure for the spread of HIV but also enabling more people to live full and productive lives Can offer a broader range of services – through training and ongoing mentoring at the facility level, an expanded range of services can be offered. Over the last few years services are strongly linked with the HIV coinfectants of STI and TB. Emphasis has been put on making facilities “one stop shops” where people can access the full range of services in the one location Contribute to national surveillance system – the size of the CHASI network puts in a prime position to make a meaningful contribution to data collection and analysis. To date PNG’s national surveillance system has not been accurate. CHASI is working with partners to improve its own surveillance system so that it can better contribute to the national surveillance system

Successes CHASI facilities provide close to a third of all counselling and testing in PNG Almost a third of people get their ART from Catholic-run facilities HIV services are offered in 115 sites in 21 provinces Clinical supervision is conducted regularly in 8 provinces CHASI organises an average of 12 trainings a year resulting in almost 400 health and non health workers being trained in areas such as PICT, IMAI and counselling 68,443 people were tested in Catholic facilities 2013 4,259 people get their ART from Catholic-run facilities

Challenges To keep up with the international standards in resource poor settings Competing priorities Attribution of achievements Payment of allowances CHASI strives to have the highest standards possible. However in resource poor settings, that are sometimes dangerous, and are often cut off from reliable communication and transportation infrastructure, this can be very difficult. It has an adverse impact on staff morale and consequently service delivery. While development partners generally share common goals they can have different priorities. This can manifest itself in areas such as availability of key people and data collection. All development partners want to share in, and own, the successes. This can be quite tense and even divisive. There is also an ethical dimension: is it right to take credit for something that others have done? CHASI is overcoming this by adopting a policy of freely sharing information with partners where there is a clear link to their involvement. As a Church organisation, CHASI does not pay additional allowances for people to attend trainings, meetings etc when it has covered all costs. However, several of CHASI’s partners do that. This creates significant tension amongst participates and can be a real distraction